Tuesday, 25 August 2015

Therapeutic Self-knowledge

This post is by Fleur Jongepier, a PhD Student at the Radboud University Nijmegen, the Netherlands. Her research focuses on self-knowledge and first-person authority. Here Fleur (in the picture above) summarises a paper that she is currently working on with her colleague Derek Strijbos (in the picture below), psychiatry resident (Dimence) and Postdoctoral Research Fellow in philosophy.

Self-knowledge regarding one’s mental states comes in many forms. One can know about one’s mental states in a more or less ‘theoretical’ way, e.g. through reading about it in a psychology book or listening to the folk theories and advice of others, and on that basis make a conjecture about one’s own state of mind. For instance, one may become convinced that one has abandonment issues, and this piece of theoretical self-knowledge might motivate one to seek treatment.

An alternative to ‘theoretical’ self-knowledge is deliberative or agential self-knowledge. To use one of Richard Moran’s examples (2001, p. 26), imagine asking someone whether she intends to pay back the money she borrowed. Suppose she answers: 'As far as I can tell, yes'. What makes this response particularly disturbing is that it appears to be issued from an onlooker’s perspective, as if she were talking about someone else. We generally do not accept such answers precisely because they signal a lack of first-person involvement. We demand that others play an active part in coming to know their own mental states; we demand that they make up their mind, i.e. decide whether they shall pay back the money.

On the agential view, self-knowledge is understood in terms of a person’s capacity to actively engage with and shape her own mental states. Moran explains the first-personal authority we have regarding our own mental states in terms of 1) transparent avowal of one’s mental states by means of 2) rational deliberation. According to what he calls the ‘transparency condition’ of first-person statements of e.g. one’s beliefs, one should treat the question of one’s belief about P as equivalent to the question of the truth of P. One defers answering the self-directed question 'Do I believe that P?' to answering the world-directed question 'Is it the case that P?' This second, world-directed question ('Is it the case that P?') is a deliberative question, which is issued from the first-person.

Moran’s understanding of authoritative self-knowledge in terms of deliberative avowal is, we argue, a good starting point for thinking about self-knowledge in psychotherapy. Deliberative avowal implies a normative stance of commitment toward the relevant states. Consider a depressed patient who, with the help of her therapist, becomes consciously aware of a previously implicit belief, e.g., that she is worthless as a person. Upon reflection she comes to the conclusion this belief is false and that, in fact, she is basically OK as a person. Authorizing this contrary belief through deliberative avowal can be regarded as a turning point in therapy in the sense that it marks the patient’s commitment to a new (and more adaptive) appraisal of herself.

Though the commissive component in Moran’s model is, we think, promising, there is reason to be sceptical about both the emphasis on rational deliberation but also about transparency itself. I shall here concentrate on the second worry.

The problem is that, when trying to find out what we feel, want or believe, we cannot always trust our transparent outlook on the world. Jonathan Lear (2004) provides an illuminating discussion of ‘Mr. A’, a borderline patient, who constantly interprets events in his life under the concept of betrayal. For instance, Mr. A will interpret his girlfriend’s angry outburst as a long-expected exposure of her true feelings towards him, and criticizes himself for having made himself so vulnerable for this betrayal in the first place (2004, p. 450). The problem for Mr. A, as Lear explains, is that the reasons he gives to support his beliefs and feelings fulfill a constraining function, rather than one that facilitates (rational) freedom and mental health. The more Mr. A transparently avows, the more locked in he will become in his interpretative schemas.

Deliberative avowals can thus function as a defence mechanism that effectively blocks more appropriate forms of self-understanding. The (in)adequacy of transparent avowals is a major focus in therapy. In the treatment of borderline personality disorder, for example, treatment mainly consists in teaching patients, not how to (dis)avow their mental states, but rather how to regulate these attitudes and their inclinations to avow them in situations of arousal or crisis. The focus is on their mental states themselves (and so is in that sense opaque), rather than, as Moran suggests would be the mark of mental health, reflecting on the reasons for the belief that p or feeling q.

The mistake, we argue, is to construe the theoretical or opaque self-relation exclusively as a ‘scientific’ or alienated self-relation. In our paper, we propose a ‘dual perspective’ account of therapeutic self-knowledge. According to our account, genuine insight into one’s (dysfunctional) beliefs, desires, or emotions requires that one avows these states from a first-person or point of view, while at the same time regulating this avowal from an opaque though adaptive, trusting perspective on oneself.